CS/CS/HB 651

1	A bill to be entitled
2	An act relating to the Agency for Health Care
3	Administration; repealing s. 395.0199, F.S., relating to
4	private utilization review of health care services;
5	amending ss. 395.405 and 400.0712, F.S.; conforming cross-
6	references; amending s. 400.118, F.S.; removing provisions
7	requiring quality-of-care monitors for nursing facilities
8	in agency district offices; amending s. 400.141, F.S.;
9	revising reporting requirements for facility staff-to-
10	resident ratios; deleting a requirement that licensed
11	nursing home facilities provide the agency with a monthly
12	report on the number of vacant beds in the facility;
13	amending s. 400.147, F.S.; revising reporting requirements
14	under facility internal risk management and quality
15	assurance programs; revising the definition of the term
16	"adverse incident" for reporting purposes; requiring
17	abuse, neglect, and exploitation to be reported to the
18	agency and the Department of Children and Family Services;
19	deleting a requirement that the agency submit an annual
20	report on nursing home adverse incidents to the
21	Legislature; amending s. 400.162, F.S.; revising
22	provisions relating to procedures and policies regarding
23	the safekeeping of nursing home residents' property;
24	amending s. 400.195, F.S.; conforming a cross-reference;
25	amending s. 400.23, F.S.; deleting provisions relating to
26	minimum staffing requirements for nursing homes; amending
27	s. 400.474, F.S.; providing that specified provisions
28	relating to remuneration do not apply to or preclude
29	certain payment practices permitted under specified
30	federal laws or regulations; amending s. 400.506, F.S.;
31	exempting nurse registries not participating in the
32	Medicaid or Medicare program from certain disciplinary
33	actions for paying remuneration to certain entities in
34	exchange for patient referrals; amending s. 400.9905,
35	F.S.; revising the definition of the term "clinic" to
36	provide that pt. X of ch. 400, F.S., the Health Care
37	Clinic Act, does not apply to entities that do not seek
38	reimbursement from insurance companies for medical
39	services paid pursuant to personal injury protection
40	coverage; amending s. 400.9935, F.S.; revising
41	accreditation requirements for clinics providing magnetic
42	resonance imaging services; providing for a unique
43	identification number for licensed clinics and entities
44	holding certificates of exemption; requiring the agency to
45	assign unique identification numbers, under certain
46	circumstances, and publish the numbers on its Internet
47	website in a specified format; amending s. 400.995, F.S.;
48	revising agency responsibilities with respect to personnel
49	and operations in certain injunctive proceedings; amending
50	s. 408.803, F.S.; revising definitions applicable to pt.
51	II of ch. 408, F.S., the "Health Care Licensing Procedures
52	Act"; amending s. 408.806, F.S.; revising contents of and
53	procedures relating to health care provider applications
54	for licensure; providing an exception from certain
55	licensure inspections for adult family-care homes;
56	authorizing the agency to provide electronic access to
57	certain information and documents; amending s. 408.808,
58	F.S.; providing for a provisional license to be issued to
59	applicants applying for a change of ownership; providing a
60	time limit on provisional licenses; amending s. 408.809,
61	F.S.; revising provisions relating to background screening
62	of specified employees; exempting certain persons from
63	rescreening; permitting certain persons to apply for an
64	exemption from disqualification under certain
65	circumstances; requiring health care providers to submit
66	to the agency an affidavit of compliance with background
67	screening requirements at the time of license renewal;
68	deleting a provision to conform to changes made by the
69	act; amending s. 408.810, F.S.; revising provisions
70	relating to information required for licensure; amending
71	s. 408.811, F.S.; providing for certain inspections to be
72	accepted in lieu of complete licensure inspections;
73	granting agency access to records requested during an
74	offsite review; providing timeframes for correction of
75	certain deficiencies and submission of plans to correct
76	such deficiencies; amending s. 408.813, F.S.; providing
77	classifications of violations of pt. II of ch. 408, F.S.;
78	providing for fines; amending s. 408.820, F.S.; revising
79	applicability of exemptions from specified requirements of
80	pt. II of ch. 408, F.S.; conforming references; creating
81	s. 408.821, F.S.; requiring entities regulated or licensed
82	by the agency to designate a safety liaison for emergency
83	operations; providing that entities regulated or licensed
84	by the agency may temporarily exceed their licensed
85	capacity to act as receiving providers under specified
86	circumstances; providing requirements while such entities
87	are in an overcapacity status; providing for issuance of
88	an inactive license to such licensees under specified
89	conditions; providing requirements and procedures with
90	respect to the issuance and reactivation of an inactive
91	license; authorizing the agency to adopt rules; amending
92	s. 408.831, F.S.; deleting provisions relating to
93	authorization for entities regulated or licensed by the
94	agency to exceed their licensed capacity to act as
95	receiving facilities and issuance and reactivation of
96	inactive licenses; amending s. 409.221, F.S.; conforming a
97	cross-reference; amending s. 409.901, F.S.; revising a
98	definition applicable to Medicaid providers; repealing s.
99	429.071, F.S., relating to the intergenerational respite
100	care assisted living facility pilot program; amending s.
101	429.08, F.S.; authorizing the agency to provide
102	information regarding licensed assisted living facilities
103	electronically or on its Internet website; abolishing
104	local coordinating workgroups established by agency field
105	offices; deleting a fine; deleting provisions requiring
106	the agency to provide certain information and notice to
107	service providers; amending s. 429.14, F.S.; conforming a
108	reference; amending s. 429.19, F.S.; revising agency
109	procedures for imposition of fines for violations of pt. I
110	of ch. 429, F.S., the "Assisted Living Facilities Act";
111	providing for the posting of certain information
112	electronically or on the agency's Internet website;
113	amending s. 429.23, F.S.; revising the definition of the
114	term "adverse incident" for reporting purposes; requiring
115	abuse, neglect, and exploitation to be reported to the
116	agency and the Department of Children and Family Services;
117	deleting a requirement that the agency submit an annual
118	report on assisted living facility adverse incidents to
119	the Legislature; amending s. 429.26, F.S.; removing
120	requirement for a resident of an assisted living facility
121	to undergo examinations and evaluations under certain
122	circumstances; amending s. 430.80, F.S.; conforming a
123	cross-reference; amending ss. 435.04 and 435.05, F.S.;
124	requiring employers of certain employees to submit an
125	affidavit of compliance with level 2 screening
126	requirements at the time of license renewal; amending s.
127	483.031, F.S.; conforming a reference; amending s.
128	483.041, F.S.; revising a definition applicable to pt. I
129	of ch. 483, F.S., the "Florida Clinical Laboratory Law";
130	repealing s. 483.106, F.S., relating to applications for
131	certificates of exemption by clinical laboratories that
132	perform certain tests; amending s. 483.172, F.S.;
133	conforming a reference; amending s. 627.4239, F.S.;
134	revising the definition of the term "standard reference
135	compendium" for purposes of regulating the insurance
136	coverage of drugs used in the treatment of cancer;
137	amending s. 627.736, F.S.; providing that personal injury
138	protection insurance carriers are not required to pay
139	claims or charges for service or treatment billed by a
140	provider not holding an identification number issued by
141	the agency; amending s. 651.118, F.S.; conforming a cross-
142	reference; providing an effective date.
143
144	Be It Enacted by the Legislature of the State of Florida:
145
146	Section 1.  Section 395.0199, Florida Statutes, is
147	repealed.
148	Section 2.  Section 395.405, Florida Statutes, is amended
149	to read:
150	395.405  Rulemaking.--The department shall adopt and
151	enforce all rules necessary to administer ss. 395.0199, 395.401,
152	395.4015, 395.402, 395.4025, 395.403, 395.404, and 395.4045.
153	Section 3.  Subsection (1) of section 400.0712, Florida
154	Statutes, is amended to read:
155	400.0712  Application for inactive license.--
156	(1)  As specified in s. 408.831(4) and this section, the
157	agency may issue an inactive license to a nursing home facility
158	for all or a portion of its beds. Any request by a licensee that
159	a nursing home or portion of a nursing home become inactive must
160	be submitted to the agency in the approved format. The facility
161	may not initiate any suspension of services, notify residents,
162	or initiate inactivity before receiving approval from the
163	agency; and a licensee that violates this provision may not be
164	issued an inactive license.
165	Section 4.  Subsection (3) of section 400.118, Florida
166	Statutes, is renumbered as subsection (2), and present
167	subsection (2) of that section is amended to read:
168	400.118  Quality assurance; early warning system;
169	monitoring; rapid response teams.--
170	(2)(a)  The agency shall establish within each district
171	office one or more quality-of-care monitors, based on the number
172	of nursing facilities in the district, to monitor all nursing
173	facilities in the district on a regular, unannounced, aperiodic
174	basis, including nights, evenings, weekends, and holidays.
175	Quality-of-care monitors shall visit each nursing facility at
176	least quarterly. Priority for additional monitoring visits shall
177	be given to nursing facilities with a history of resident care
178	deficiencies. Quality-of-care monitors shall be registered
179	nurses who are trained and experienced in nursing facility
180	regulation, standards of practice in long-term care, and
181	evaluation of patient care. Individuals in these positions shall
182	not be deployed by the agency as a part of the district survey
183	team in the conduct of routine, scheduled surveys, but shall
184	function solely and independently as quality-of-care monitors.
185	Quality-of-care monitors shall assess the overall quality of
186	life in the nursing facility and shall assess specific
187	conditions in the facility directly related to resident care,
188	including the operations of internal quality improvement and
189	risk management programs and adverse incident reports. The
190	quality-of-care monitor shall include in an assessment visit
191	observation of the care and services rendered to residents and
192	formal and informal interviews with residents, family members,
193	facility staff, resident guests, volunteers, other regulatory
194	staff, and representatives of a long-term care ombudsman council
195	or Florida advocacy council.
196	(b)  Findings of a monitoring visit, both positive and
197	negative, shall be provided orally and in writing to the
198	facility administrator or, in the absence of the facility
199	administrator, to the administrator on duty or the director of
200	nursing. The quality-of-care monitor may recommend to the
201	facility administrator procedural and policy changes and staff
202	training, as needed, to improve the care or quality of life of
203	facility residents. Conditions observed by the quality-of-care
204	monitor which threaten the health or safety of a resident shall
205	be reported immediately to the agency area office supervisor for
206	appropriate regulatory action and, as appropriate or as required
207	by law, to law enforcement, adult protective services, or other
208	responsible agencies.
209	(c)  Any record, whether written or oral, or any written or
210	oral communication generated pursuant to paragraph (a) or
211	paragraph (b) shall not be subject to discovery or introduction
212	into evidence in any civil or administrative action against a
213	nursing facility arising out of matters which are the subject of
214	quality-of-care monitoring, and a person who was in attendance
215	at a monitoring visit or evaluation may not be permitted or
216	required to testify in any such civil or administrative action
217	as to any evidence or other matters produced or presented during
218	the monitoring visits or evaluations. However, information,
219	documents, or records otherwise available from original sources
220	are not to be construed as immune from discovery or use in any
221	such civil or administrative action merely because they were
222	presented during monitoring visits or evaluations, and any
223	person who participates in such activities may not be prevented
224	from testifying as to matters within his or her knowledge, but
225	such witness may not be asked about his or her participation in
226	such activities. The exclusion from the discovery or
227	introduction of evidence in any civil or administrative action
228	provided for herein shall not apply when the quality-of-care
229	monitor makes a report to the appropriate authorities regarding
230	a threat to the health or safety of a resident.
231	Section 5.  Section 400.141, Florida Statutes, is amended
232	to read:
233	400.141  Administration and management of nursing home
234	facilities.--
235	(1)  Every licensed facility shall comply with all
236	applicable standards and rules of the agency and shall:
237	(a)(1)  Be under the administrative direction and charge of
238	a licensed administrator.
239	(b)(2)  Appoint a medical director licensed pursuant to
240	chapter 458 or chapter 459. The agency may establish by rule
241	more specific criteria for the appointment of a medical
242	director.
243	(c)(3)  Have available the regular, consultative, and
244	emergency services of physicians licensed by the state.
245	(d)(4)  Provide for resident use of a community pharmacy as
246	specified in s. 400.022(1)(q). Any other law to the contrary
247	notwithstanding, a registered pharmacist licensed in Florida,
248	that is under contract with a facility licensed under this
249	chapter or chapter 429, shall repackage a nursing facility
250	resident's bulk prescription medication which has been packaged
251	by another pharmacist licensed in any state in the United States
252	into a unit dose system compatible with the system used by the
253	nursing facility, if the pharmacist is requested to offer such
254	service. In order to be eligible for the repackaging, a resident
255	or the resident's spouse must receive prescription medication
256	benefits provided through a former employer as part of his or
257	her retirement benefits, a qualified pension plan as specified
258	in s. 4972 of the Internal Revenue Code, a federal retirement
259	program as specified under 5 C.F.R. s. 831, or a long-term care
260	policy as defined in s. 627.9404(1). A pharmacist who correctly
261	repackages and relabels the medication and the nursing facility
262	which correctly administers such repackaged medication under the
263	provisions of this paragraph may subsection shall not be held
264	liable in any civil or administrative action arising from the
265	repackaging. In order to be eligible for the repackaging, a
266	nursing facility resident for whom the medication is to be
267	repackaged shall sign an informed consent form provided by the
268	facility which includes an explanation of the repackaging
269	process and which notifies the resident of the immunities from
270	liability provided in this paragraph herein. A pharmacist who
271	repackages and relabels prescription medications, as authorized
272	under this paragraph subsection, may charge a reasonable fee for
273	costs resulting from the implementation of this provision.
274	(e)(5)  Provide for the access of the facility residents to
275	dental and other health-related services, recreational services,
276	rehabilitative services, and social work services appropriate to
277	their needs and conditions and not directly furnished by the
278	licensee. When a geriatric outpatient nurse clinic is conducted
279	in accordance with rules adopted by the agency, outpatients
280	attending such clinic shall not be counted as part of the
281	general resident population of the nursing home facility, nor
282	shall the nursing staff of the geriatric outpatient clinic be
283	counted as part of the nursing staff of the facility, until the
284	outpatient clinic load exceeds 15 a day.
285	(f)(6)  Be allowed and encouraged by the agency to provide
286	other needed services under certain conditions. If the facility
287	has a standard licensure status, and has had no class I or class
288	II deficiencies during the past 2 years or has been awarded a
289	Gold Seal under the program established in s. 400.235, it may be
290	encouraged by the agency to provide services, including, but not
291	limited to, respite and adult day services, which enable
292	individuals to move in and out of the facility. A facility is
293	not subject to any additional licensure requirements for
294	providing these services. Respite care may be offered to persons
295	in need of short-term or temporary nursing home services.
296	Respite care must be provided in accordance with this part and
297	rules adopted by the agency. However, the agency shall, by rule,
298	adopt modified requirements for resident assessment, resident
299	care plans, resident contracts, physician orders, and other
300	provisions, as appropriate, for short-term or temporary nursing
301	home services. The agency shall allow for shared programming and
302	staff in a facility which meets minimum standards and offers
303	services pursuant to this paragraph subsection, but, if the
304	facility is cited for deficiencies in patient care, may require
305	additional staff and programs appropriate to the needs of
306	service recipients. A person who receives respite care may not
307	be counted as a resident of the facility for purposes of the
308	facility's licensed capacity unless that person receives 24-hour
309	respite care. A person receiving either respite care for 24
310	hours or longer or adult day services must be included when
311	calculating minimum staffing for the facility. Any costs and
312	revenues generated by a nursing home facility from
313	nonresidential programs or services shall be excluded from the
314	calculations of Medicaid per diems for nursing home
315	institutional care reimbursement.
316	(g)(7)  If the facility has a standard license or is a Gold
317	Seal facility, exceeds the minimum required hours of licensed
318	nursing and certified nursing assistant direct care per resident
319	per day, and is part of a continuing care facility licensed
320	under chapter 651 or a retirement community that offers other
321	services pursuant to part III of this chapter or part I or part
322	III of chapter 429 on a single campus, be allowed to share
323	programming and staff. At the time of inspection and in the
324	semiannual report required pursuant to paragraph (o) subsection
325	(15), a continuing care facility or retirement community that
326	uses this option must demonstrate through staffing records that
327	minimum staffing requirements for the facility were met.
328	Licensed nurses and certified nursing assistants who work in the
329	nursing home facility may be used to provide services elsewhere
330	on campus if the facility exceeds the minimum number of direct
331	care hours required per resident per day and the total number of
332	residents receiving direct care services from a licensed nurse
333	or a certified nursing assistant does not cause the facility to
334	violate the staffing ratios required under s. 400.23(3)(a).
335	Compliance with the minimum staffing ratios shall be based on
336	total number of residents receiving direct care services,
337	regardless of where they reside on campus. If the facility
338	receives a conditional license, it may not share staff until the
339	conditional license status ends. This paragraph subsection does
340	not restrict the agency's authority under federal or state law
341	to require additional staff if a facility is cited for
342	deficiencies in care which are caused by an insufficient number
343	of certified nursing assistants or licensed nurses. The agency
344	may adopt rules for the documentation necessary to determine
345	compliance with this provision.
346	(h)(8)  Maintain the facility premises and equipment and
347	conduct its operations in a safe and sanitary manner.
348	(i)(9)  If the licensee furnishes food service, provide a
349	wholesome and nourishing diet sufficient to meet generally
350	accepted standards of proper nutrition for its residents and
351	provide such therapeutic diets as may be prescribed by attending
352	physicians. In making rules to implement this paragraph
353	subsection, the agency shall be guided by standards recommended
354	by nationally recognized professional groups and associations
355	with knowledge of dietetics.
356	(j)(10)  Keep full records of resident admissions and
357	discharges; medical and general health status, including medical
358	records, personal and social history, and identity and address
359	of next of kin or other persons who may have responsibility for
360	the affairs of the residents; and individual resident care plans
361	including, but not limited to, prescribed services, service
362	frequency and duration, and service goals. The records shall be
363	open to inspection by the agency.
364	(k)(11)  Keep such fiscal records of its operations and
365	conditions as may be necessary to provide information pursuant
366	to this part.
367	(l)(12)  Furnish copies of personnel records for employees
368	affiliated with such facility, to any other facility licensed by
369	this state requesting this information pursuant to this part.
370	Such information contained in the records may include, but is
371	not limited to, disciplinary matters and any reason for
372	termination. Any facility releasing such records pursuant to
373	this part shall be considered to be acting in good faith and may
374	not be held liable for information contained in such records,
375	absent a showing that the facility maliciously falsified such
376	records.
377	(m)(13)  Publicly display a poster provided by the agency
378	containing the names, addresses, and telephone numbers for the
379	state's abuse hotline, the State Long-Term Care Ombudsman, the
380	Agency for Health Care Administration consumer hotline, the
381	Advocacy Center for Persons with Disabilities, the Florida
382	Statewide Advocacy Council, and the Medicaid Fraud Control Unit,
383	with a clear description of the assistance to be expected from
384	each.
385	(n)(14)  Submit to the agency the information specified in
386	s. 400.071(1)(b) for a management company within 30 days after
387	the effective date of the management agreement.
388	(o)1.(15)  Submit semiannually to the agency, or more
389	frequently if requested by the agency, information regarding
390	facility staff-to-resident ratios, staff turnover, and staff
391	stability, including information regarding certified nursing
392	assistants, licensed nurses, the director of nursing, and the
393	facility administrator. For purposes of this reporting:
394	a.(a)  Staff-to-resident ratios must be reported in the
395	categories specified in s. 400.23(3)(a) and applicable rules.
396	The ratio must be reported as an average for the most recent
397	calendar quarter.
398	b.(b)  Staff turnover must be reported for the most recent
399	12-month period ending on the last workday of the most recent
400	calendar quarter prior to the date the information is submitted.
401	The turnover rate must be computed quarterly, with the annual
402	rate being the cumulative sum of the quarterly rates. The
403	turnover rate is the total number of terminations or separations
404	experienced during the quarter, excluding any employee
405	terminated during a probationary period of 3 months or less,
406	divided by the total number of staff employed at the end of the
407	period for which the rate is computed, and expressed as a
408	percentage.
409	c.(c)  The formula for determining staff stability is the
410	total number of employees that have been employed for more than
411	12 months, divided by the total number of employees employed at
412	the end of the most recent calendar quarter, and expressed as a
413	percentage.
414	d.(d)  A nursing facility that has failed to comply with
415	state minimum-staffing requirements for 2 consecutive days is
416	prohibited from accepting new admissions until the facility has
417	achieved the minimum-staffing requirements for a period of 6
418	consecutive days. For the purposes of this sub-subparagraph
419	paragraph, any person who was a resident of the facility and was
420	absent from the facility for the purpose of receiving medical
421	care at a separate location or was on a leave of absence is not
422	considered a new admission. Failure to impose such an admissions
423	moratorium constitutes a class II deficiency.
424	e.(e)  A nursing facility which does not have a conditional
425	license may be cited for failure to comply with the standards in
426	s. 400.23(3)(a)1.a. only if it has failed to meet those
427	standards on 2 consecutive days or if it has failed to meet at
428	least 97 percent of those standards on any one day.
429	f.(f)  A facility which has a conditional license must be
430	in compliance with the standards in s. 400.23(3)(a) at all
431	times.
432	2.  Nothing in This paragraph does not section shall limit
433	the agency's ability to impose a deficiency or take other
434	actions if a facility does not have enough staff to meet the
435	residents' needs.
436	(16)  Report monthly the number of vacant beds in the
437	facility which are available for resident occupancy on the day
438	the information is reported.
439	(p)(17)  Notify a licensed physician when a resident
440	exhibits signs of dementia or cognitive impairment or has a
441	change of condition in order to rule out the presence of an
442	underlying physiological condition that may be contributing to
443	such dementia or impairment. The notification must occur within
444	30 days after the acknowledgment of such signs by facility
445	staff. If an underlying condition is determined to exist, the
446	facility shall arrange, with the appropriate health care
447	provider, the necessary care and services to treat the
448	condition.
449	(q)(18)  If the facility implements a dining and
450	hospitality attendant program, ensure that the program is
451	developed and implemented under the supervision of the facility
452	director of nursing. A licensed nurse, licensed speech or
453	occupational therapist, or a registered dietitian must conduct
454	training of dining and hospitality attendants. A person employed
455	by a facility as a dining and hospitality attendant must perform
456	tasks under the direct supervision of a licensed nurse.
457	(r)(19)  Report to the agency any filing for bankruptcy
458	protection by the facility or its parent corporation,
459	divestiture or spin-off of its assets, or corporate
460	reorganization within 30 days after the completion of such
461	activity.
462	(s)(20)  Maintain general and professional liability
463	insurance coverage that is in force at all times. In lieu of
464	general and professional liability insurance coverage, a state-
465	designated teaching nursing home and its affiliated assisted
466	living facilities created under s. 430.80 may demonstrate proof
467	of financial responsibility as provided in s. 430.80(3)(h).
468	(t)(21)  Maintain in the medical record for each resident a
469	daily chart of certified nursing assistant services provided to
470	the resident. The certified nursing assistant who is caring for
471	the resident must complete this record by the end of his or her
472	shift. This record must indicate assistance with activities of
473	daily living, assistance with eating, and assistance with
474	drinking, and must record each offering of nutrition and
475	hydration for those residents whose plan of care or assessment
476	indicates a risk for malnutrition or dehydration.
477	(u)(22)  Before November 30 of each year, subject to the
478	availability of an adequate supply of the necessary vaccine,
479	provide for immunizations against influenza viruses to all its
480	consenting residents in accordance with the recommendations of
481	the United States Centers for Disease Control and Prevention,
482	subject to exemptions for medical contraindications and
483	religious or personal beliefs. Subject to these exemptions, any
484	consenting person who becomes a resident of the facility after
485	November 30 but before March 31 of the following year must be
486	immunized within 5 working days after becoming a resident.
487	Immunization shall not be provided to any resident who provides
488	documentation that he or she has been immunized as required by
489	this paragraph subsection. This paragraph subsection does not
490	prohibit a resident from receiving the immunization from his or
491	her personal physician if he or she so chooses. A resident who
492	chooses to receive the immunization from his or her personal
493	physician shall provide proof of immunization to the facility.
494	The agency may adopt and enforce any rules necessary to comply
495	with or implement this paragraph subsection.
496	(v)(23)  Assess all residents for eligibility for
497	pneumococcal polysaccharide vaccination (PPV) and vaccinate
498	residents when indicated within 60 days after the effective date
499	of this act in accordance with the recommendations of the United
500	States Centers for Disease Control and Prevention, subject to
501	exemptions for medical contraindications and religious or
502	personal beliefs. Residents admitted after the effective date of
503	this act shall be assessed within 5 working days of admission
504	and, when indicated, vaccinated within 60 days in accordance
505	with the recommendations of the United States Centers for
506	Disease Control and Prevention, subject to exemptions for
507	medical contraindications and religious or personal beliefs.
508	Immunization shall not be provided to any resident who provides
509	documentation that he or she has been immunized as required by
510	this paragraph subsection. This paragraph subsection does not
511	prohibit a resident from receiving the immunization from his or
512	her personal physician if he or she so chooses. A resident who
513	chooses to receive the immunization from his or her personal
514	physician shall provide proof of immunization to the facility.
515	The agency may adopt and enforce any rules necessary to comply
516	with or implement this paragraph subsection.
517	(w)(24)  Annually encourage and promote to its employees
518	the benefits associated with immunizations against influenza
519	viruses in accordance with the recommendations of the United
520	States Centers for Disease Control and Prevention. The agency
521	may adopt and enforce any rules necessary to comply with or
522	implement this paragraph subsection.
523	(2)  Facilities that have been awarded a Gold Seal under
524	the program established in s. 400.235 may develop a plan to
525	provide certified nursing assistant training as prescribed by
526	federal regulations and state rules and may apply to the agency
527	for approval of their program.
528	Section 6.  Present subsections (9) through (13) of section
529	400.147, Florida Statutes, are renumbered as subsections (10)
530	through (14), respectively, subsection (5) and present
531	subsection (14) are amended, and a new subsection (9) is added
532	to that section, to read:
533	400.147  Internal risk management and quality assurance
534	program.--
535	(5)  For purposes of reporting to the agency under this
536	section, the term "adverse incident" means:
537	(a)  An event over which facility personnel could exercise
538	control and which is associated in whole or in part with the
539	facility's intervention, rather than the condition for which
540	such intervention occurred, and which results in one of the
541	following:
542	1.  Death;
543	2.  Brain or spinal damage;
544	3.  Permanent disfigurement;
545	4.  Fracture or dislocation of bones or joints;
546	5.  A limitation of neurological, physical, or sensory
547	function;
548	6.  Any condition that required medical attention to which
549	the resident has not given his or her informed consent,
550	including failure to honor advanced directives; or
551	7.  Any condition that required the transfer of the
552	resident, within or outside the facility, to a unit providing a
553	more acute level of care due to the adverse incident, rather
554	than the resident's condition prior to the adverse incident; or
555	8.  An event that is reported to law enforcement or its
556	personnel for investigation; or
557	(b)  Abuse, neglect, or exploitation as defined in s.
558	415.102;
559	(c)  Abuse, neglect and harm as defined in s. 39.01;
560	(b)(d)  Resident elopement, if the elopement places the
561	resident at risk of harm or injury.; or
562	(e)  An event that is reported to law enforcement.
563	(9)  Abuse, neglect, or exploitation must be reported to
564	the agency as required by 42 C.F.R. s. 483.13(c) and to the
565	department as required by chapters 39 and 415.
566	(14)  The agency shall annually submit to the Legislature a
567	report on nursing home adverse incidents. The report must
568	include the following information arranged by county:
569	(a)  The total number of adverse incidents.
570	(b)  A listing, by category, of the types of adverse
571	incidents, the number of incidents occurring within each
572	category, and the type of staff involved.
573	(c)  A listing, by category, of the types of injury caused
574	and the number of injuries occurring within each category.
575	(d)  Types of liability claims filed based on an adverse
576	incident or reportable injury.
577	(e)  Disciplinary action taken against staff, categorized
578	by type of staff involved.
579	Section 7.  Subsection (3) of section 400.162, Florida
580	Statutes, is amended to read:
581	400.162  Property and personal affairs of residents.--
582	(3)  A licensee shall provide for the safekeeping of
583	personal effects, funds, and other property of the resident in
584	the facility. Whenever necessary for the protection of
585	valuables, or in order to avoid unreasonable responsibility
586	therefor, the licensee may require that such valuables be
587	excluded or removed from the facility and kept at some place not
588	subject to the control of the licensee. At the request of a
589	resident, the facility shall mark the resident's personal
590	property with the resident's name or another type of
591	identification, without defacing the property. Any theft or loss
592	of a resident's personal property shall be documented by the
593	facility. The facility shall develop policies and procedures to
594	minimize the risk of theft or loss of the personal property of
595	residents. A copy of the policy shall be provided to every
596	employee and to each resident and resident's representative, if
597	appropriate, at admission and when revised. Facility policies
598	must include provisions related to reporting theft or loss of a
599	resident's property to law enforcement and any facility waiver
600	of liability for loss or theft. The facility shall post notice
601	of these policies and procedures, and any revision thereof, in
602	places accessible to residents.
603	Section 8.  Paragraph (d) of subsection (1) of section
604	400.195, Florida Statutes, is amended to read:
605	400.195  Agency reporting requirements.--
606	(1)  For the period beginning June 30, 2001, and ending
607	June 30, 2005, the Agency for Health Care Administration shall
608	provide a report to the Governor, the President of the Senate,
609	and the Speaker of the House of Representatives with respect to
610	nursing homes. The first report shall be submitted no later than
611	December 30, 2002, and subsequent reports shall be submitted
612	every 6 months thereafter. The report shall identify facilities
613	based on their ownership characteristics, size, business
614	structure, for-profit or not-for-profit status, and any other
615	characteristics the agency determines useful in analyzing the
616	varied segments of the nursing home industry and shall report:
617	(d)  Information regarding deficiencies cited, including
618	information used to develop the Nursing Home Guide WATCH LIST
619	pursuant to s. 400.191, and applicable rules, a summary of data
620	generated on nursing homes by Centers for Medicare and Medicaid
621	Services Nursing Home Quality Information Project, and
622	information collected pursuant to s. 400.147(10)(9), relating to
623	litigation.
624	Section 9.  Paragraph (b) of subsection (3) of section
625	400.23, Florida Statutes, is amended to read:
626	400.23  Rules; evaluation and deficiencies; licensure
627	status.--
628	(3)
629	(b)  The agency shall adopt rules to allow properly trained
630	staff of a nursing facility, in addition to certified nursing
631	assistants and licensed nurses, to assist residents with eating.
632	The rules shall specify the minimum training requirements and
633	shall specify the physiological conditions or disorders of
634	residents which would necessitate that the eating assistance be
635	provided by nursing personnel of the facility. Nonnursing staff
636	providing eating assistance to residents under the provisions of
637	this subsection shall not count toward compliance with minimum
638	staffing standards.
639	Section 10.  Subsection (6) of section 400.474, Florida
640	Statutes, is amended to read:
641	400.474  Administrative penalties.--
642	(6)  The agency may deny, revoke, or suspend the license of
643	a home health agency and shall impose a fine of $5,000 against a
644	home health agency that:
645	(a)  Gives remuneration for staffing services to:
646	1.  Another home health agency with which it has formal or
647	informal patient-referral transactions or arrangements; or
648	2.  A health services pool with which it has formal or
649	informal patient-referral transactions or arrangements,
650
651	unless the home health agency has activated its comprehensive
652	emergency management plan in accordance with s. 400.492. This
653	paragraph does not apply to a Medicare-certified home health
654	agency that provides fair market value remuneration for staffing
655	services to a non-Medicare-certified home health agency that is
656	part of a continuing care facility licensed under chapter 651
657	for providing services to its own residents if each resident
658	receiving home health services pursuant to this arrangement
659	attests in writing that he or she made a decision without
660	influence from staff of the facility to select, from a list of
661	Medicare-certified home health agencies provided by the
662	facility, that Medicare-certified home health agency to provide
663	the services.
664	(b)  Provides services to residents in an assisted living
665	facility for which the home health agency does not receive fair
666	market value remuneration.
667	(c)  Provides staffing to an assisted living facility for
668	which the home health agency does not receive fair market value
669	remuneration.
670	(d)  Fails to provide the agency, upon request, with copies
671	of all contracts with assisted living facilities which were
672	executed within 5 years before the request.
673	(e)  Gives remuneration to a case manager, discharge
674	planner, facility-based staff member, or third-party vendor who
675	is involved in the discharge planning process of a facility
676	licensed under chapter 395 or this chapter from whom the home
677	health agency receives referrals.
678	(f)  Fails to submit to the agency, within 15 days after
679	the end of each calendar quarter, a written report that includes
680	the following data based on data as it existed on the last day
681	of the quarter:
682	1.  The number of insulin-dependent diabetic patients
683	receiving insulin-injection services from the home health
684	agency;
685	2.  The number of patients receiving both home health
686	services from the home health agency and hospice services;
687	3.  The number of patients receiving home health services
688	from that home health agency; and
689	4.  The names and license numbers of nurses whose primary
690	job responsibility is to provide home health services to
691	patients and who received remuneration from the home health
692	agency in excess of $25,000 during the calendar quarter.
693	(g)  Gives cash, or its equivalent, to a Medicare or
694	Medicaid beneficiary.
695	(h)  Has more than one medical director contract in effect
696	at one time or more than one medical director contract and one
697	contract with a physician-specialist whose services are mandated
698	for the home health agency in order to qualify to participate in
699	a federal or state health care program at one time.
700	(i)  Gives remuneration to a physician without a medical
701	director contract being in effect. The contract must:
702	1.  Be in writing and signed by both parties;
703	2.  Provide for remuneration that is at fair market value
704	for an hourly rate, which must be supported by invoices
705	submitted by the medical director describing the work performed,
706	the dates on which that work was performed, and the duration of
707	that work; and
708	3.  Be for a term of at least 1 year.
709
710	The hourly rate specified in the contract may not be increased
711	during the term of the contract. The home health agency may not
712	execute a subsequent contract with that physician which has an
713	increased hourly rate and covers any portion of the term that
714	was in the original contract.
715	(j)  Gives remuneration to:
716	1.  A physician, and the home health agency is in violation
717	of paragraph (h) or paragraph (i);
718	2.  A member of the physician's office staff; or
719	3.  An immediate family member of the physician,
720
721	if the home health agency has received a patient referral in the
722	preceding 12 months from that physician or physician's office
723	staff.
724	(k)  Fails to provide to the agency, upon request, copies
725	of all contracts with a medical director which were executed
726	within 5 years before the request.
727
728	Nothing in paragraph (e) or paragraph (j) shall be interpreted
729	as applying to or precluding any discount, compensation, waiver
730	of payment, or payment practice permitted by 42 U.S.C. s. 1320a-
731	7b(b) or regulations adopted thereunder, including 42 C.F.R. s.
732	1001.952, or by 42 U.S.C. s. 1395nn or regulations adopted
733	thereunder.
734	Section 11.  Paragraph (a) of subsection (15) of section
735	400.506, Florida Statutes, is amended to read:
736	400.506  Licensure of nurse registries; requirements;
737	penalties.--
738	(15)(a)  The agency may deny, suspend, or revoke the
739	license of a nurse registry and shall impose a fine of $5,000
740	against a nurse registry that:
741	1.  Provides services to residents in an assisted living
742	facility for which the nurse registry does not receive fair
743	market value remuneration.
744	2.  Provides staffing to an assisted living facility for
745	which the nurse registry does not receive fair market value
746	remuneration.
747	3.  Fails to provide the agency, upon request, with copies
748	of all contracts with assisted living facilities which were
749	executed within the last 5 years.
750	4.  Gives remuneration to a case manager, discharge
751	planner, facility-based staff member, or third-party vendor who
752	is involved in the discharge planning process of a facility
753	licensed under chapter 395 or this chapter and from whom the
754	nurse registry receives referrals. This subparagraph does not
755	apply to a nurse registry that does not participate in the
756	Medicaid or Medicare program.
757	5.  Gives remuneration to a physician, a member of the
758	physician's office staff, or an immediate family member of the
759	physician, and the nurse registry received a patient referral in
760	the last 12 months from that physician or the physician's office
761	staff. This subparagraph does not apply to a nurse registry that
762	does not participate in the Medicaid or Medicare program.
763	Section 12.  Paragraph (m) is added to subsection (4) of
764	section 400.9905, Florida Statutes, to read:
765	400.9905  Definitions.--
766	(4)  "Clinic" means an entity at which health care services
767	are provided to individuals and which tenders charges for
768	reimbursement for such services, including a mobile clinic and a
769	portable equipment provider. For purposes of this part, the term
770	does not include and the licensure requirements of this part do
771	not apply to:
772	(m)  Entities that do not seek reimbursement from insurance
773	companies for medical services paid pursuant to personal injury
774	protection coverage required by s. 627.736.
775	Section 13.  Paragraph (a) of subsection (7) of section
776	400.9935, Florida Statutes, is amended, and subsection (10) is
777	added to that section, to read:
778	400.9935  Clinic responsibilities.--
779	(7)(a)  Each clinic engaged in magnetic resonance imaging
780	services must be accredited by the Joint Commission on
781	Accreditation of Healthcare Organizations, the American College
782	of Radiology, or the Accreditation Association for Ambulatory
783	Health Care, within 1 year after licensure. A clinic that is
784	accredited by the American College of Radiology or is within the
785	original 1-year period after licensure and replaces its core
786	magnetic resonance imaging equipment shall be given 1 year after
787	the date upon which the equipment is replaced to attain
788	accreditation. However, a clinic may request a single, 6-month
789	extension if it provides evidence to the agency establishing
790	that, for good cause shown, such clinic cannot can not be
791	accredited within 1 year after licensure, and that such
792	accreditation will be completed within the 6-month extension.
793	After obtaining accreditation as required by this subsection,
794	each such clinic must maintain accreditation as a condition of
795	renewal of its license. A clinic that files a change of
796	ownership application must comply with the original
797	accreditation timeframe requirements of the transferor. The
798	agency shall deny a change of ownership application if the
799	clinic is not in compliance with the accreditation requirements.
800	When a clinic adds, replaces, or modifies magnetic resonance
801	imaging equipment and the accrediting organization requires new
802	accreditation, the clinic must be accredited within 1 year after
803	the date of the addition, replacement, or modification but may
804	request a single, 6-month extension if the clinic provides
805	evidence of good cause to the agency.
806	(10)  Any clinic holding an active license and any entity
807	holding a current certificate of exemption may request a unique
808	identification number from the agency for the purposes of
809	submitting claims to personal injury protection insurance
810	carriers for services or treatment pursuant to part XI of
811	chapter 627. Upon request, the agency shall assign a unique
812	identification number to a clinic holding an active license or
813	an entity holding a current certificate of exemption. The agency
814	shall publish the identification number of each clinic and
815	entity on its Internet website in a searchable format that is
816	readily accessible to personal injury protection insurance
817	carriers for the purposes of s. 627.736(5)(b)1.g.
818	Section 14.  Subsection (6) of section 400.995, Florida
819	Statutes, is amended to read:
820	400.995  Agency administrative penalties.--
821	(6)  During an inspection, the agency, as an alternative to
822	or in conjunction with an administrative action against a clinic
823	for violations of this part and adopted rules, shall make a
824	reasonable attempt to discuss each violation and recommended
825	corrective action with the owner, medical director, or clinic
826	director of the clinic, prior to written notification. The
827	agency, instead of fixing a period within which the clinic shall
828	enter into compliance with standards, may request a plan of
829	corrective action from the clinic which demonstrates a good
830	faith effort to remedy each violation by a specific date,
831	subject to the approval of the agency.
832	Section 15.  Subsections (5) and (9) of section 408.803,
833	Florida Statutes, are amended to read:
834	408.803  Definitions.--As used in this part, the term:
835	(5)  "Change of ownership" means:
836	(a)  An event in which the licensee sells or otherwise
837	transfers its ownership changes to a different individual or
838	legal entity, as evidenced by a change in federal employer
839	identification number or taxpayer identification number; or
840	(b)  An event in which 51 45 percent or more of the
841	ownership, voting shares, membership, or controlling interest of
842	a licensee is in any manner transferred or otherwise assigned.
843	This paragraph does not apply to a licensee that is publicly
844	traded on a recognized stock exchange. In a corporation whose
845	shares are not publicly traded on a recognized stock exchange is
846	transferred or assigned, including the final transfer or
847	assignment of multiple transfers or assignments over a 2-year
848	period that cumulatively total 45 percent or greater.
849
850	A change solely in the management company or board of directors
851	is not a change of ownership.
852	(9)  "Licensee" means an individual, corporation,
853	partnership, firm, association, or governmental entity, or other
854	entity that is issued a permit, registration, certificate, or
855	license by the agency. The licensee is legally responsible for
856	all aspects of the provider operation.
857	Section 16.  Paragraph (a) of subsection (1), subsection
858	(2), paragraph (c) of subsection (7), and subsection (8) of
859	section 408.806, Florida Statutes, are amended to read:
860	408.806  License application process.--
861	(1)  An application for licensure must be made to the
862	agency on forms furnished by the agency, submitted under oath,
863	and accompanied by the appropriate fee in order to be accepted
864	and considered timely. The application must contain information
865	required by authorizing statutes and applicable rules and must
866	include:
867	(a)  The name, address, and social security number of:
868	1.  The applicant;
869	2.  The administrator or a similarly titled person who is
870	responsible for the day-to-day operation of the provider;
871	3.  The financial officer or similarly titled person who is
872	responsible for the financial operation of the licensee or
873	provider; and
874	4.  Each controlling interest if the applicant or
875	controlling interest is an individual.
876	(2)(a)  The applicant for a renewal license must submit an
877	application that must be received by the agency at least 60 days
878	but no more than 120 days prior to the expiration of the current
879	license. An application received more than 120 days prior to the
880	expiration of the current license shall be returned to the
881	applicant. If the renewal application and fee are received prior
882	to the license expiration date, the license shall not be deemed
883	to have expired if the license expiration date occurs during the
884	agency's review of the renewal application.
885	(b)  The applicant for initial licensure due to a change of
886	ownership must submit an application that must be received by
887	the agency at least 60 days prior to the date of change of
888	ownership.
889	(c)  For any other application or request, the applicant
890	must submit an application or request that must be received by
891	the agency at least 60 days but no more than 120 days prior to
892	the requested effective date, unless otherwise specified in
893	authorizing statutes or applicable rules. An application
894	received more than 120 days prior to the requested effective
895	date shall be returned to the applicant.
896	(d)  The agency shall notify the licensee by mail or
897	electronically at least 90 days prior to the expiration of a
898	license that a renewal license is necessary to continue
899	operation. The failure to timely submit a renewal application
900	and license fee shall result in a $50 per day late fee charged
901	to the licensee by the agency; however, the aggregate amount of
902	the late fee may not exceed 50 percent of the licensure fee or
903	$500, whichever is less. If an application is received after the
904	required filing date and exhibits a hand-canceled postmark
905	obtained from a United States post office dated on or before the
906	required filing date, no fine will be levied.
907	(7)
908	(c)  If an inspection is required by the authorizing
909	statute for a license application other than an initial
910	application, the inspection must be unannounced. This paragraph
911	does not apply to inspections required pursuant to ss. 383.324,
912	395.0161(4), 429.67(6), and 483.061(2).
913	(8)  The agency may establish procedures for the electronic
914	notification and submission of required information, including,
915	but not limited to:
916	(a)  Licensure applications.
917	(b)  Required signatures.
918	(c)  Payment of fees.
919	(d)  Notarization of applications.
920
921	Requirements for electronic submission of any documents required
922	by this part or authorizing statutes may be established by rule.
923	As an alternative to sending documents as required by
924	authorizing statutes, the agency may provide electronic access
925	to information or documents.
926	Section 17.  Subsection (2) of section 408.808, Florida
927	Statutes, is amended to read:
928	408.808  License categories.--
929	(2)  PROVISIONAL LICENSE.--A provisional license may be
930	issued to an applicant pursuant to s. 408.809(3). An applicant
931	against whom a proceeding denying or revoking a license is
932	pending at the time of license renewal may be issued a
933	provisional license effective until final action not subject to
934	further appeal. A provisional license may also be issued to an
935	applicant applying for a change of ownership. A provisional
936	license shall be limited in duration to a specific period of
937	time, not to exceed 12 months, as determined by the agency.
938	Section 18.  Subsection (5) of section 408.809, Florida
939	Statutes, is amended, and new subsections (5) and (6) are added
940	to that section, to read:
941	408.809  Background screening; prohibited offenses.--
942	(5)  Effective October 1, 2009, in addition to the offenses
943	listed in ss. 435.03 and 435.04, all persons required to undergo
944	background screening pursuant to this part or authorizing
945	statutes must not have been found guilty of, regardless of
946	adjudication, or entered a plea of nolo contendere or guilty to,
947	any of the following offenses or any similar offense of another
948	jurisdiction:
949	(a)  A violation of any authorizing statutes, if the
950	offense was a felony.
951	(b)  A violation of this chapter, if the offense was a
952	felony.
953	(c)  A violation of s. 409.920, relating to Medicaid
954	provider fraud, if the offense was a felony.
955	(d)  A violation of s. 409.9201, relating to Medicaid
956	fraud, if the offense was a felony.
957	(e)  A violation of s. 741.28, relating to domestic
958	violence.
959	(f)  A violation of chapter 784, relating to assault,
960	battery, and culpable negligence, if the offense was a felony.
961	(g)  A violation of s. 810.02, relating to burglary.
962	(h)  A violation of s. 817.034, relating to fraudulent acts
963	through mail, wire, radio, electromagnetic, photoelectronic, or
964	photooptical systems.
965	(i)  A violation of s. 817.234, relating to false and
966	fraudulent insurance claims.
967	(j)  A violation of s. 817.505, relating to patient
968	brokering.
969	(k)  A violation of s. 817.568, relating to criminal use of
970	personal identification information.
971	(l)  A violation of s. 817.60, relating to obtaining a
972	credit card through fraudulent means.
973	(m)  A violation of s. 817.61, relating to fraudulent use
974	of credit cards, if the offense was a felony.
975	(n)  A violation of s. 831.01, relating to forgery.
976	(o)  A violation of s. 831.02, relating to uttering forged
977	instruments.
978	(p)  A violation of s. 831.07, relating to forging bank
979	bills, checks, drafts, or promissory notes.
980	(q)  A violation of s. 831.09, relating to uttering forged
981	bank bills, checks, drafts, or promissory notes.
982	(r)  A violation of s. 831.30, relating to fraud in
983	obtaining medicinal drugs.
984	(s)  A violation of s. 831.31, relating to the sale,
985	manufacture, delivery, or possession with the intent to sell,
986	manufacture, or deliver any counterfeit controlled substance, if
987	the offense was a felony.
988
989	A person who serves as a controlling interest of or is employed
990	by a licensee on September 30, 2009, shall not be required by
991	law to submit to rescreening if that licensee has in its
992	possession written evidence that the person has been screened
993	and qualified according to the standards specified in s. 435.03
994	or s. 435.04. However, if such person has been convicted of a
995	disqualifying offense listed in this subsection, he or she may
996	apply for an exemption from the appropriate licensing agency
997	before September 30, 2009, and if agreed to by the employer, may
998	continue to perform his or her duties until the licensing agency
999	renders a decision on the application for exemption for an
1000	offense listed in this subsection. Exemptions from
1001	disqualification may be granted pursuant to s. 435.07.
1002	(6)  The attestations required under ss. 435.04(5) and
1003	435.05(3) must be submitted at the time of license renewal,
1004	notwithstanding the provisions of ss. 435.04(5) and 435.05(3)
1005	which require annual submission of an affidavit of compliance
1006	with background screening requirements.
1007	(5)  Background screening is not required to obtain a
1008	certificate of exemption issued under s. 483.106.
1009	Section 19.  Subsection (3) of section 408.810, Florida
1010	Statutes, is amended to read:
1011	408.810  Minimum licensure requirements.--In addition to
1012	the licensure requirements specified in this part, authorizing
1013	statutes, and applicable rules, each applicant and licensee must
1014	comply with the requirements of this section in order to obtain
1015	and maintain a license.
1016	(3)  Unless otherwise specified in this part, authorizing
1017	statutes, or applicable rules, any information required to be
1018	reported to the agency must be submitted within 21 calendar days
1019	after the report period or effective date of the information,
1020	whichever is earlier, including, but not limited to, any change
1021	of:
1022	(a)  Information contained in the most recent application
1023	for licensure.
1024	(b)  Required insurance or bonds.
1025	Section 20.  Present subsection (4) of section 408.811,
1026	Florida Statutes, is renumbered as subsection (6), subsections
1027	(2) and (3) are amended, and new subsections (4) and (5) are
1028	added to that section, to read:
1029	408.811  Right of inspection; copies; inspection reports;
1030	plan for correction of deficiencies.--
1031	(2)  Inspections conducted in conjunction with
1032	certification, comparable licensure requirements, or a
1033	recognized or approved accreditation organization may be
1034	accepted in lieu of a complete licensure inspection. However, a
1035	licensure inspection may also be conducted to review any
1036	licensure requirements that are not also requirements for
1037	certification.
1038	(3)  The agency shall have access to and the licensee shall
1039	provide, or if requested send, copies of all provider records
1040	required during an inspection or other review at no cost to the
1041	agency, including records requested during an offsite review.
1042	(4)  Deficiencies must be corrected within 30 calendar days
1043	after the provider is notified of inspection results unless an
1044	alternative timeframe is required or approved by the agency.
1045	(5)  The agency may require an applicant or licensee to
1046	submit a plan of correction for deficiencies. If required, the
1047	plan of correction must be filed with the agency within 10
1048	calendar days after notification unless an alternative timeframe
1049	is required.
1050	Section 21.  Section 408.813, Florida Statutes, is amended
1051	to read:
1052	408.813  Administrative fines; violations.--As a penalty
1053	for any violation of this part, authorizing statutes, or
1054	applicable rules, the agency may impose an administrative fine.
1055	(1)  Unless the amount or aggregate limitation of the fine
1056	is prescribed by authorizing statutes or applicable rules, the
1057	agency may establish criteria by rule for the amount or
1058	aggregate limitation of administrative fines applicable to this
1059	part, authorizing statutes, and applicable rules. Each day of
1060	violation constitutes a separate violation and is subject to a
1061	separate fine, unless a per-violation fine is prescribed by law.
1062	For fines imposed by final order of the agency and not subject
1063	to further appeal, the violator shall pay the fine plus interest
1064	at the rate specified in s. 55.03 for each day beyond the date
1065	set by the agency for payment of the fine.
1066	(2)  Violations of this part, authorizing statutes, or
1067	applicable rules shall be classified according to the nature of
1068	the violation and the gravity of its probable effect on clients.
1069	The scope of a violation may be cited as an isolated, patterned,
1070	or widespread deficiency. An isolated deficiency is a deficiency
1071	affecting one or a very limited number of clients, or involving
1072	one or a very limited number of staff, or a situation that
1073	occurred only occasionally or in a very limited number of
1074	locations. A patterned deficiency is a deficiency in which more
1075	than a very limited number of clients are affected, or more than
1076	a very limited number of staff are involved, or the situation
1077	has occurred in several locations, or the same client or clients
1078	have been affected by repeated occurrences of the same deficient
1079	practice but the effect of the deficient practice is not found
1080	to be pervasive throughout the provider. A widespread deficiency
1081	is a deficiency in which the problems causing the deficiency are
1082	pervasive in the provider or represent systemic failure that has
1083	affected or has the potential to affect a large portion of the
1084	provider's clients. This subsection does not affect the
1085	legislative determination of the amount of a fine imposed under
1086	authorizing statutes. Violations shall be classified on the
1087	written notice as follows:
1088	(a)  Class "I" violations are those conditions or
1089	occurrences related to the operation and maintenance of a
1090	provider or to the care of clients which the agency determines
1091	present an imminent danger to the clients of the provider or a
1092	substantial probability that death or serious physical or
1093	emotional harm would result therefrom. The condition or practice
1094	constituting a class I violation shall be abated or eliminated
1095	within 24 hours, unless a fixed period, as determined by the
1096	agency, is required for correction. The agency shall impose an
1097	administrative fine as provided by law for a cited class I
1098	violation. A fine shall be levied notwithstanding the correction
1099	of the violation.
1100	(b)  Class "II" violations are those conditions or
1101	occurrences related to the operation and maintenance of a
1102	provider or to the care of clients which the agency determines
1103	directly threaten the physical or emotional health, safety, or
1104	security of the clients, other than class I violations. The
1105	agency shall impose an administrative fine as provided by law
1106	for a cited class II violation. A fine shall be levied
1107	notwithstanding the correction of the violation.
1108	(c)  Class "III" violations are those conditions or
1109	occurrences related to the operation and maintenance of a
1110	provider or to the care of clients which the agency determines
1111	indirectly or potentially threaten the physical or emotional
1112	health, safety, or security of clients, other than class I or
1113	class II violations. The agency shall impose an administrative
1114	fine as provided by law for a cited class III violation. A
1115	citation for a class III violation must specify the time within
1116	which the violation is required to be corrected. If a class III
1117	violation is corrected within the time specified, a fine may not
1118	be imposed.
1119	(d)  Class "IV" violations are those conditions or
1120	occurrences related to the operation and maintenance of a
1121	provider or to required reports, forms, or documents that do not
1122	have the potential of negatively affecting clients. These
1123	violations are of a type that the agency determines do not
1124	threaten the health, safety, or security of clients. The agency
1125	shall impose an administrative fine as provided by law for a
1126	cited class IV violation. A citation for a class IV violation
1127	must specify the time within which the violation is required to
1128	be corrected. If a class IV violation is corrected within the
1129	time specified, a fine may not be imposed.
1130	Section 22.  Subsections (12) through (16) of section
1131	408.820, Florida Statutes, are renumbered as subsections (11)
1132	through (15), respectively, subsections (18) through (26) are
1133	renumbered as subsections (16) through (24), respectively,
1134	subsections (28) and (29) are renumbered as subsections (25) and
1135	(26), respectively, and present subsections (11), (12), (17),
1136	(21), (26), and (27) of that section are amended to read:
1137	408.820  Exemptions.--Except as prescribed in authorizing
1138	statutes, the following exemptions shall apply to specified
1139	requirements of this part:
1140	(11)  Private review agents, as provided under part I of
1141	chapter 395, are exempt from ss. 408.806(7), 408.810, and
1142	408.811.
1143	(11)(12)  Health care risk managers, as provided under part
1144	I of chapter 395, are exempt from ss. 408.806(7), 408.810(4)-
1145	(10), and 408.811.
1146	(17)  Companion services or homemaker services providers,
1147	as provided under part III of chapter 400, are exempt from s.
1148	408.810(6)-(10).
1149	(19)(21)  Transitional living facilities, as provided under
1150	part V of chapter 400, are exempt from s. 408.810(7)-(10).
1151	(24)(26)  Health care clinics, as provided under part X of
1152	chapter 400, are exempt from s. ss. 408.809 and 408.810(1), (6),
1153	(7), and (10).
1154	(27)  Clinical laboratories, as provided under part I of
1155	chapter 483, are exempt from s. 408.810(5)-(10).
1156	Section 23.  Section 408.821, Florida Statutes, is created
1157	to read:
1158	408.821  Emergency management planning; emergency
1159	operations; inactive license.--
1160	(1)  Licensees required by authorizing statutes to have an
1161	emergency operations plan must designate a safety liaison to
1162	serve as the primary contact for emergency operations.
1163	(2)  An entity subject to this part may temporarily exceed
1164	its licensed capacity to act as a receiving provider in
1165	accordance with an approved emergency operations plan for up to
1166	15 days. While in an overcapacity status, each provider must
1167	furnish or arrange for appropriate care and services to all
1168	clients. In addition, the agency may approve requests for
1169	overcapacity in excess of 15 days, which approvals may be based
1170	upon satisfactory justification and need as provided by the
1171	receiving and sending providers.
1172	(3)(a)  An inactive license may be issued to a licensee
1173	subject to this section when the provider is located in a
1174	geographic area in which a state of emergency was declared by
1175	the Governor if the provider:
1176	1.  Suffered damage to its operation during the state of
1177	emergency.
1178	2.  Is currently licensed.
1179	3.  Does not have a provisional license.
1180	4.  Will be temporarily unable to provide services but is
1181	reasonably expected to resume services within 12 months.
1182	(b)  An inactive license may be issued for a period not to
1183	exceed 12 months but may be renewed by the agency for up to 12
1184	additional months upon demonstration to the agency of progress
1185	toward reopening. A request by a licensee for an inactive
1186	license or to extend the previously approved inactive period
1187	must be submitted in writing to the agency, accompanied by
1188	written justification for the inactive license, which states the
1189	beginning and ending dates of inactivity and includes a plan for
1190	the transfer of any clients to other providers and appropriate
1191	licensure fees. Upon agency approval, the licensee shall notify
1192	clients of any necessary discharge or transfer as required by
1193	authorizing statutes or applicable rules. The beginning of the
1194	inactive licensure period shall be the date the provider ceases
1195	operations. The end of the inactive period shall become the
1196	license expiration date, and all licensure fees must be current,
1197	must be paid in full, and may be prorated. Reactivation of an
1198	inactive license requires the prior approval by the agency of a
1199	renewal application, including payment of licensure fees and
1200	agency inspections indicating compliance with all requirements
1201	of this part and applicable rules and statutes.
1202	(4)  The agency may adopt rules relating to emergency
1203	management planning, communications, and operations. Licensees
1204	providing residential or inpatient services must utilize an
1205	online database approved by the agency to report information to
1206	the agency regarding the provider's emergency status, planning,
1207	or operations.
1208	Section 24.  Subsections (3), (4), and (5) of section
1209	408.831, Florida Statutes, are amended to read:
1210	408.831  Denial, suspension, or revocation of a license,
1211	registration, certificate, or application.--
1212	(3)  An entity subject to this section may exceed its
1213	licensed capacity to act as a receiving facility in accordance
1214	with an emergency operations plan for clients of evacuating
1215	providers from a geographic area where an evacuation order has
1216	been issued by a local authority having jurisdiction. While in
1217	an overcapacity status, each provider must furnish or arrange
1218	for appropriate care and services to all clients. In addition,
1219	the agency may approve requests for overcapacity beyond 15 days,
1220	which approvals may be based upon satisfactory justification and
1221	need as provided by the receiving and sending facilities.
1222	(4)(a)  An inactive license may be issued to a licensee
1223	subject to this section when the provider is located in a
1224	geographic area where a state of emergency was declared by the
1225	Governor if the provider:
1226	1.  Suffered damage to its operation during that state of
1227	emergency.
1228	2.  Is currently licensed.
1229	3.  Does not have a provisional license.
1230	4.  Will be temporarily unable to provide services but is
1231	reasonably expected to resume services within 12 months.
1232	(b)  An inactive license may be issued for a period not to
1233	exceed 12 months but may be renewed by the agency for up to 12
1234	additional months upon demonstration to the agency of progress
1235	toward reopening. A request by a licensee for an inactive
1236	license or to extend the previously approved inactive period
1237	must be submitted in writing to the agency, accompanied by
1238	written justification for the inactive license, which states the
1239	beginning and ending dates of inactivity and includes a plan for
1240	the transfer of any clients to other providers and appropriate
1241	licensure fees. Upon agency approval, the licensee shall notify
1242	clients of any necessary discharge or transfer as required by
1243	authorizing statutes or applicable rules. The beginning of the
1244	inactive licensure period shall be the date the provider ceases
1245	operations. The end of the inactive period shall become the
1246	licensee expiration date, and all licensure fees must be
1247	current, paid in full, and may be prorated. Reactivation of an
1248	inactive license requires the prior approval by the agency of a
1249	renewal application, including payment of licensure fees and
1250	agency inspections indicating compliance with all requirements
1251	of this part and applicable rules and statutes.
1252	(3)(5)  This section provides standards of enforcement
1253	applicable to all entities licensed or regulated by the Agency
1254	for Health Care Administration. This section controls over any
1255	conflicting provisions of chapters 39, 383, 390, 391, 394, 395,
1256	400, 408, 429, 468, 483, and 765 or rules adopted pursuant to
1257	those chapters.
1258	Section 25.  Paragraph (e) of subsection (4) of section
1259	409.221, Florida Statutes, is amended to read:
1260	409.221  Consumer-directed care program.--
1261	(4)  CONSUMER-DIRECTED CARE.--
1262	(e)  Services.--Consumers shall use the budget allowance
1263	only to pay for home and community-based services that meet the
1264	consumer's long-term care needs and are a cost-efficient use of
1265	funds. Such services may include, but are not limited to, the
1266	following:
1267	1.  Personal care.
1268	2.  Homemaking and chores, including housework, meals,
1269	shopping, and transportation.
1270	3.  Home modifications and assistive devices which may
1271	increase the consumer's independence or make it possible to
1272	avoid institutional placement.
1273	4.  Assistance in taking self-administered medication.
1274	5.  Day care and respite care services, including those
1275	provided by nursing home facilities pursuant to s.
1276	400.141(1)(f)(6) or by adult day care facilities licensed
1277	pursuant to s. 429.907.
1278	6.  Personal care and support services provided in an
1279	assisted living facility.
1280	Section 26.  Subsection (5) of section 409.901, Florida
1281	Statutes, is amended to read:
1282	409.901  Definitions; ss. 409.901-409.920.--As used in ss.
1283	409.901-409.920, except as otherwise specifically provided, the
1284	term:
1285	(5)  "Change of ownership" means:
1286	(a)  An event in which the provider ownership changes to a
1287	different individual legal entity, as evidenced by a change in
1288	federal employer identification number or taxpayer
1289	identification number; or
1290	(b)  An event in which 51 45 percent or more of the
1291	ownership, voting shares, membership, or controlling interest of
1292	a provider is in any manner transferred or otherwise assigned.
1293	This paragraph does not apply to a licensee that is publicly
1294	traded on a recognized stock exchange; or
1295	(c)  When the provider is licensed or registered by the
1296	agency, an event considered a change of ownership for licensure
1297	as defined in s. 408.803 in a corporation whose shares are not
1298	publicly traded on a recognized stock exchange is transferred or
1299	assigned, including the final transfer or assignment of multiple
1300	transfers or assignments over a 2-year period that cumulatively
1301	total 45 percent or more.
1302
1303	A change solely in the management company or board of directors
1304	is not a change of ownership.
1305	Section 27.  Section 429.071, Florida Statutes, is
1306	repealed.
1307	Section 28.  Paragraph (e) of subsection (1) and
1308	subsections (2) and (3) of section 429.08, Florida Statutes, are
1309	amended to read:
1310	429.08  Unlicensed facilities; referral of person for
1311	residency to unlicensed facility; penalties; verification of
1312	licensure status.--
1313	(1)
1314	(e)  The agency shall publish provide to the department's
1315	elder information and referral providers a list, by county, of
1316	licensed assisted living facilities, to assist persons who are
1317	considering an assisted living facility placement in locating a
1318	licensed facility. This information may be provided
1319	electronically or on the agency's Internet website.
1320	(2)  Each field office of the Agency for Health Care
1321	Administration shall establish a local coordinating workgroup
1322	which includes representatives of local law enforcement
1323	agencies, state attorneys, the Medicaid Fraud Control Unit of
1324	the Department of Legal Affairs, local fire authorities, the
1325	Department of Children and Family Services, the district long-
1326	term care ombudsman council, and the district human rights
1327	advocacy committee to assist in identifying the operation of
1328	unlicensed facilities and to develop and implement a plan to
1329	ensure effective enforcement of state laws relating to such
1330	facilities. The workgroup shall report its findings, actions,
1331	and recommendations semiannually to the Director of Health
1332	Quality Assurance of the agency.
1333	(2)(3)  It is unlawful to knowingly refer a person for
1334	residency to an unlicensed assisted living facility; to an
1335	assisted living facility the license of which is under denial or
1336	has been suspended or revoked; or to an assisted living facility
1337	that has a moratorium pursuant to part II of chapter 408. Any
1338	person who violates this subsection commits a noncriminal
1339	violation, punishable by a fine not exceeding $500 as provided
1340	in s. 775.083.
1341	(a)  Any health care practitioner, as defined in s.
1342	456.001, who is aware of the operation of an unlicensed facility
1343	shall report that facility to the agency. Failure to report a
1344	facility that the practitioner knows or has reasonable cause to
1345	suspect is unlicensed shall be reported to the practitioner's
1346	licensing board.
1347	(b)  Any provider as defined in s. 408.803 that hospital or
1348	community mental health center licensed under chapter 395 or
1349	chapter 394 which knowingly discharges a patient or client to an
1350	unlicensed facility is subject to sanction by the agency.
1351	(c)  Any employee of the agency or department, or the
1352	Department of Children and Family Services, who knowingly refers
1353	a person for residency to an unlicensed facility; to a facility
1354	the license of which is under denial or has been suspended or
1355	revoked; or to a facility that has a moratorium pursuant to part
1356	II of chapter 408 is subject to disciplinary action by the
1357	agency or department, or the Department of Children and Family
1358	Services.
1359	(d)  The employer of any person who is under contract with
1360	the agency or department, or the Department of Children and
1361	Family Services, and who knowingly refers a person for residency
1362	to an unlicensed facility; to a facility the license of which is
1363	under denial or has been suspended or revoked; or to a facility
1364	that has a moratorium pursuant to part II of chapter 408 shall
1365	be fined and required to prepare a corrective action plan
1366	designed to prevent such referrals.
1367	(e)  The agency shall provide the department and the
1368	Department of Children and Family Services with a list of
1369	licensed facilities within each county and shall update the list
1370	at least quarterly.
1371	(f)  At least annually, the agency shall notify, in
1372	appropriate trade publications, physicians licensed under
1373	chapter 458 or chapter 459, hospitals licensed under chapter
1374	395, nursing home facilities licensed under part II of chapter
1375	400, and employees of the agency or the department, or the
1376	Department of Children and Family Services, who are responsible
1377	for referring persons for residency, that it is unlawful to
1378	knowingly refer a person for residency to an unlicensed assisted
1379	living facility and shall notify them of the penalty for
1380	violating such prohibition. The department and the Department of
1381	Children and Family Services shall, in turn, notify service
1382	providers under contract to the respective departments who have
1383	responsibility for resident referrals to facilities. Further,
1384	the notice must direct each noticed facility and individual to
1385	contact the appropriate agency office in order to verify the
1386	licensure status of any facility prior to referring any person
1387	for residency. Each notice must include the name, telephone
1388	number, and mailing address of the appropriate office to
1389	contact.
1390	Section 29.  Paragraph (e) of subsection (1) of section
1391	429.14, Florida Statutes, is amended to read:
1392	429.14  Administrative penalties.--
1393	(1)  In addition to the requirements of part II of chapter
1394	408, the agency may deny, revoke, and suspend any license issued
1395	under this part and impose an administrative fine in the manner
1396	provided in chapter 120 against a licensee of an assisted living
1397	facility for a violation of any provision of this part, part II
1398	of chapter 408, or applicable rules, or for any of the following
1399	actions by a licensee of an assisted living facility, for the
1400	actions of any person subject to level 2 background screening
1401	under s. 408.809, or for the actions of any facility employee:
1402	(e)  A citation of any of the following deficiencies as
1403	specified defined in s. 429.19:
1404	1.  One or more cited class I deficiencies.
1405	2.  Three or more cited class II deficiencies.
1406	3.  Five or more cited class III deficiencies that have
1407	been cited on a single survey and have not been corrected within
1408	the times specified.
1409	Section 30.  Subsections (2), (8), and (9) of section
1410	429.19, Florida Statutes, are amended to read:
1411	429.19  Violations; imposition of administrative fines;
1412	grounds.--
1413	(2)  Each violation of this part and adopted rules shall be
1414	classified according to the nature of the violation and the
1415	gravity of its probable effect on facility residents. The agency
1416	shall indicate the classification on the written notice of the
1417	violation as follows:
1418	(a)  Class "I" violations are defined in s. 408.813 those
1419	conditions or occurrences related to the operation and
1420	maintenance of a facility or to the personal care of residents
1421	which the agency determines present an imminent danger to the
1422	residents or guests of the facility or a substantial probability
1423	that death or serious physical or emotional harm would result
1424	therefrom. The condition or practice constituting a class I
1425	violation shall be abated or eliminated within 24 hours, unless
1426	a fixed period, as determined by the agency, is required for
1427	correction. The agency shall impose an administrative fine for a
1428	cited class I violation in an amount not less than $5,000 and
1429	not exceeding $10,000 for each violation. A fine may be levied
1430	notwithstanding the correction of the violation.
1431	(b)  Class "II" violations are defined in s. 408.813 those
1432	conditions or occurrences related to the operation and
1433	maintenance of a facility or to the personal care of residents
1434	which the agency determines directly threaten the physical or
1435	emotional health, safety, or security of the facility residents,
1436	other than class I violations. The agency shall impose an
1437	administrative fine for a cited class II violation in an amount
1438	not less than $1,000 and not exceeding $5,000 for each
1439	violation. A fine shall be levied notwithstanding the correction
1440	of the violation.
1441	(c)  Class "III" violations are defined in s. 408.813 those
1442	conditions or occurrences related to the operation and
1443	maintenance of a facility or to the personal care of residents
1444	which the agency determines indirectly or potentially threaten
1445	the physical or emotional health, safety, or security of
1446	facility residents, other than class I or class II violations.
1447	The agency shall impose an administrative fine for a cited class
1448	III violation in an amount not less than $500 and not exceeding
1449	$1,000 for each violation. A citation for a class III violation
1450	must specify the time within which the violation is required to
1451	be corrected. If a class III violation is corrected within the
1452	time specified, no fine may be imposed, unless it is a repeated
1453	offense.
1454	(d)  Class "IV" violations are defined in s. 408.813 those
1455	conditions or occurrences related to the operation and
1456	maintenance of a building or to required reports, forms, or
1457	documents that do not have the potential of negatively affecting
1458	residents. These violations are of a type that the agency
1459	determines do not threaten the health, safety, or security of
1460	residents of the facility. The agency shall impose an
1461	administrative fine for a cited class IV violation in an amount
1462	not less than $100 and not exceeding $200 for each violation. A
1463	citation for a class IV violation must specify the time within
1464	which the violation is required to be corrected. If a class IV
1465	violation is corrected within the time specified, no fine shall
1466	be imposed. Any class IV violation that is corrected during the
1467	time an agency survey is being conducted will be identified as
1468	an agency finding and not as a violation.
1469	(8)  During an inspection, the agency, as an alternative to
1470	or in conjunction with an administrative action against a
1471	facility for violations of this part and adopted rules, shall
1472	make a reasonable attempt to discuss each violation and
1473	recommended corrective action with the owner or administrator of
1474	the facility, prior to written notification. The agency, instead
1475	of fixing a period within which the facility shall enter into
1476	compliance with standards, may request a plan of corrective
1477	action from the facility which demonstrates a good faith effort
1478	to remedy each violation by a specific date, subject to the
1479	approval of the agency.
1480	(9)  The agency shall develop and disseminate an annual
1481	list of all facilities sanctioned or fined $5,000 or more for
1482	violations of state standards, the number and class of
1483	violations involved, the penalties imposed, and the current
1484	status of cases. The list shall be disseminated, at no charge,
1485	to the Department of Elderly Affairs, the Department of Health,
1486	the Department of Children and Family Services, the Agency for
1487	Persons with Disabilities, the area agencies on aging, the
1488	Florida Statewide Advocacy Council, and the state and local
1489	ombudsman councils. The Department of Children and Family
1490	Services shall disseminate the list to service providers under
1491	contract to the department who are responsible for referring
1492	persons to a facility for residency. The agency may charge a fee
1493	commensurate with the cost of printing and postage to other
1494	interested parties requesting a copy of this list. This
1495	information may be provided electronically or on the agency's
1496	Internet website.
1497	Section 31.  Subsections (2) and (6) of section 429.23,
1498	Florida Statutes, are amended to read:
1499	429.23  Internal risk management and quality assurance
1500	program; adverse incidents and reporting requirements.--
1501	(2)  Every facility licensed under this part is required to
1502	maintain adverse incident reports. For purposes of this section,
1503	the term, "adverse incident" means:
1504	(a)  An event over which facility personnel could exercise
1505	control rather than as a result of the resident's condition and
1506	results in:
1507	1.  Death;
1508	2.  Brain or spinal damage;
1509	3.  Permanent disfigurement;
1510	4.  Fracture or dislocation of bones or joints;
1511	5.  Any condition that required medical attention to which
1512	the resident has not given his or her consent, including failure
1513	to honor advanced directives;
1514	6.  Any condition that requires the transfer of the
1515	resident from the facility to a unit providing more acute care
1516	due to the incident rather than the resident's condition before
1517	the incident; or.
1518	7.  An event that is reported to law enforcement or its
1519	personnel for investigation; or
1520	(b)  Abuse, neglect, or exploitation as defined in s.
1521	415.102;
1522	(c)  Events reported to law enforcement; or
1523	(b)(d)  Resident elopement, if the elopement places the
1524	resident at risk of harm or injury.
1525	(6)  Abuse, neglect, or exploitation must be reported to
1526	the Department of Children and Family Services as required under
1527	chapter 415. The agency shall annually submit to the Legislature
1528	a report on assisted living facility adverse incident reports.
1529	The report must include the following information arranged by
1530	county:
1531	(a)  A total number of adverse incidents;
1532	(b)  A listing, by category, of the type of adverse
1533	incidents occurring within each category and the type of staff
1534	involved;
1535	(c)  A listing, by category, of the types of injuries, if
1536	any, and the number of injuries occurring within each category;
1537	(d)  Types of liability claims filed based on an adverse
1538	incident report or reportable injury; and
1539	(e)  Disciplinary action taken against staff, categorized
1540	by the type of staff involved.
1541	Section 32.  Subsections (10) through (12) of section
1542	429.26, Florida Statutes, are renumbered as subsections (9)
1543	through (11), respectively, and present subsection (9) of that
1544	section is amended to read:
1545	429.26  Appropriateness of placements; examinations of
1546	residents.--
1547	(9)  If, at any time after admission to a facility, a
1548	resident appears to need care beyond that which the facility is
1549	licensed to provide, the agency shall require the resident to be
1550	physically examined by a licensed physician, physician
1551	assistant, or licensed nurse practitioner. This examination
1552	shall, to the extent possible, be performed by the resident's
1553	preferred physician or nurse practitioner and shall be paid for
1554	by the resident with personal funds, except as provided in s.
1555	429.18(2). Following this examination, the examining physician,
1556	physician assistant, or licensed nurse practitioner shall
1557	complete and sign a medical form provided by the agency. The
1558	completed medical form shall be submitted to the agency within
1559	30 days after the date the facility owner or administrator is
1560	notified by the agency that the physical examination is
1561	required. After consultation with the physician, physician
1562	assistant, or licensed nurse practitioner who performed the
1563	examination, a medical review team designated by the agency
1564	shall then determine whether the resident is appropriately
1565	residing in the facility. The medical review team shall base its
1566	decision on a comprehensive review of the resident's physical
1567	and functional status, including the resident's preferences, and
1568	not on an isolated health-related problem. In the case of a
1569	mental health resident, if the resident appears to have needs in
1570	addition to those identified in the community living support
1571	plan, the agency may require an evaluation by a mental health
1572	professional, as determined by the Department of Children and
1573	Family Services. A facility may not be required to retain a
1574	resident who requires more services or care than the facility is
1575	able to provide in accordance with its policies and criteria for
1576	admission and continued residency. Members of the medical review
1577	team making the final determination may not include the agency
1578	personnel who initially questioned the appropriateness of a
1579	resident's placement. Such determination is final and binding
1580	upon the facility and the resident. Any resident who is
1581	determined by the medical review team to be inappropriately
1582	residing in a facility shall be given 30 days' written notice to
1583	relocate by the owner or administrator, unless the resident's
1584	continued residence in the facility presents an imminent danger
1585	to the health, safety, or welfare of the resident or a
1586	substantial probability exists that death or serious physical
1587	harm would result to the resident if allowed to remain in the
1588	facility.
1589	Section 33.  Paragraph (h) of subsection (3) of section
1590	430.80, Florida Statutes, is amended to read:
1591	430.80  Implementation of a teaching nursing home pilot
1592	project.--
1593	(3)  To be designated as a teaching nursing home, a nursing
1594	home licensee must, at a minimum:
1595	(h)  Maintain insurance coverage pursuant to s.
1596	400.141(1)(s)(20) or proof of financial responsibility in a
1597	minimum amount of $750,000. Such proof of financial
1598	responsibility may include:
1599	1.  Maintaining an escrow account consisting of cash or
1600	assets eligible for deposit in accordance with s. 625.52; or
1601	2.  Obtaining and maintaining pursuant to chapter 675 an
1602	unexpired, irrevocable, nontransferable and nonassignable letter
1603	of credit issued by any bank or savings association organized
1604	and existing under the laws of this state or any bank or savings
1605	association organized under the laws of the United States that
1606	has its principal place of business in this state or has a
1607	branch office which is authorized to receive deposits in this
1608	state. The letter of credit shall be used to satisfy the
1609	obligation of the facility to the claimant upon presentment of a
1610	final judgment indicating liability and awarding damages to be
1611	paid by the facility or upon presentment of a settlement
1612	agreement signed by all parties to the agreement when such final
1613	judgment or settlement is a result of a liability claim against
1614	the facility.
1615	Section 34.  Subsection (5) of section 435.04, Florida
1616	Statutes, is amended to read:
1617	435.04  Level 2 screening standards.--
1618	(5)  Under penalty of perjury, all employees in such
1619	positions of trust or responsibility shall attest to meeting the
1620	requirements for qualifying for employment and agreeing to
1621	inform the employer immediately if convicted of any of the
1622	disqualifying offenses while employed by the employer. Each
1623	employer of employees in such positions of trust or
1624	responsibilities which is licensed or registered by a state
1625	agency shall submit to the licensing agency annually or at the
1626	time of license renewal, under penalty of perjury, an affidavit
1627	of compliance with the provisions of this section.
1628	Section 35.  Subsection (3) of section 435.05, Florida
1629	Statutes, is amended to read:
1630	435.05  Requirements for covered employees.--Except as
1631	otherwise provided by law, the following requirements shall
1632	apply to covered employees:
1633	(3)  Each employer required to conduct level 2 background
1634	screening must sign an affidavit annually or at the time of
1635	license renewal, under penalty of perjury, stating that all
1636	covered employees have been screened or are newly hired and are
1637	awaiting the results of the required screening checks.
1638	Section 36.  Subsection (2) of section 483.031, Florida
1639	Statutes, is amended to read:
1640	483.031  Application of part; exemptions.--This part
1641	applies to all clinical laboratories within this state, except:
1642	(2)  A clinical laboratory that performs only waived tests
1643	and has received a certificate of exemption from the agency
1644	under s. 483.106.
1645	Section 37.  Subsection (10) of section 483.041, Florida
1646	Statutes, is amended to read:
1647	483.041  Definitions.--As used in this part, the term:
1648	(10)  "Waived test" means a test that the federal Centers
1649	for Medicare and Medicaid Services Health Care Financing
1650	Administration has determined qualifies for a certificate of
1651	waiver under the federal Clinical Laboratory Improvement
1652	Amendments of 1988, and the federal rules adopted thereunder.
1653	Section 38.  Section 483.106, Florida Statutes, is
1654	repealed.
1655	Section 39.  Subsection (3) of section 483.172, Florida
1656	Statutes, is amended to read:
1657	483.172  License fees.--
1658	(3)  The agency shall assess a biennial fee of $100 for a
1659	certificate of exemption and a $100 biennial license fee under
1660	this section for facilities surveyed by an approved accrediting
1661	organization.
1662	Section 40.  Paragraph (b) of subsection (1) of section
1663	627.4239, Florida Statutes, is amended to read:
1664	627.4239  Coverage for use of drugs in treatment of
1665	cancer.--
1666	(1)  DEFINITIONS.--As used in this section, the term:
1667	(b)  "Standard reference compendium" means authoritative
1668	compendia identified by the Secretary of the United States
1669	Department of Health and Human Services and recognized by the
1670	federal Centers for Medicare and Medicaid Services:
1671	1.  The United States Pharmacopeia Drug Information;
1672	2.  The American Medical Association Drug Evaluations; or
1673	3.  The American Hospital Formulary Service Drug
1674	Information.
1675	Section 41.  Paragraph (b) of subsection (5) of section
1676	627.736, Florida Statutes, is amended to read:
1677	627.736  Required personal injury protection benefits;
1678	exclusions; priority; claims.--
1679	(5)  CHARGES FOR TREATMENT OF INJURED PERSONS.--
1680	(b)1.  An insurer or insured is not required to pay a claim
1681	or charges:
1682	a.  Made by a broker or by a person making a claim on
1683	behalf of a broker;
1684	b.  For any service or treatment that was not lawful at the
1685	time rendered;
1686	c.  To any person who knowingly submits a false or
1687	misleading statement relating to the claim or charges;
1688	d.  With respect to a bill or statement that does not
1689	substantially meet the applicable requirements of paragraph (d);
1690	e.  For any treatment or service that is upcoded, or that
1691	is unbundled when such treatment or services should be bundled,
1692	in accordance with paragraph (d). To facilitate prompt payment
1693	of lawful services, an insurer may change codes that it
1694	determines to have been improperly or incorrectly upcoded or
1695	unbundled, and may make payment based on the changed codes,
1696	without affecting the right of the provider to dispute the
1697	change by the insurer, provided that before doing so, the
1698	insurer must contact the health care provider and discuss the
1699	reasons for the insurer's change and the health care provider's
1700	reason for the coding, or make a reasonable good faith effort to
1701	do so, as documented in the insurer's file; and
1702	f.  For medical services or treatment billed by a physician
1703	and not provided in a hospital unless such services are rendered
1704	by the physician or are incident to his or her professional
1705	services and are included on the physician's bill, including
1706	documentation verifying that the physician is responsible for
1707	the medical services that were rendered and billed; and
1708	g.  For any service or treatment billed by a provider not
1709	holding an identification number issued by the agency pursuant
1710	to s. 400.9935(10).
1711	2.  The Department of Health, in consultation with the
1712	appropriate professional licensing boards, shall adopt, by rule,
1713	a list of diagnostic tests deemed not to be medically necessary
1714	for use in the treatment of persons sustaining bodily injury
1715	covered by personal injury protection benefits under this
1716	section. The initial list shall be adopted by January 1, 2004,
1717	and shall be revised from time to time as determined by the
1718	Department of Health, in consultation with the respective
1719	professional licensing boards. Inclusion of a test on the list
1720	of invalid diagnostic tests shall be based on lack of
1721	demonstrated medical value and a level of general acceptance by
1722	the relevant provider community and shall not be dependent for
1723	results entirely upon subjective patient response.
1724	Notwithstanding its inclusion on a fee schedule in this
1725	subsection, an insurer or insured is not required to pay any
1726	charges or reimburse claims for any invalid diagnostic test as
1727	determined by the Department of Health.
1728	Section 42.  Subsection (13) of section 651.118, Florida
1729	Statutes, is amended to read:
1730	651.118  Agency for Health Care Administration;
1731	certificates of need; sheltered beds; community beds.--
1732	(13)  Residents, as defined in this chapter, are not
1733	considered new admissions for the purpose of s.
1734	400.141(1)(o)1.d.(15)(d).
1735	Section 43.  This act shall take effect upon becoming a
1736	law.

CODING: Words stricken are deletions; words underlined are additions.